Why Colorado lawmakers fear “an implosion” of the health safety net
At Thursday's Joint Budget Committee meeting , state lawmakers learned that the Department of Health Care Policy and Financing, or HCPF, overspent last year's budget by as much as $154 million. That's put the state in an even deeper financial hole than budget writers had already feared.
State health officials say the spending overruns reflect an aging population that simply needs more care than in years past. But lawmakers say health care providers across the state are facing a very different problem. Far from benefiting from the rise in state spending, they're seeing a surge in uncompensated care that's straining the state's medical safety net just as federal pandemic aid dollars run out.
"We have to find ways — financially creative or otherwise — to make sure that we are not closing clinics and losing infrastructure that we had built prior to the pandemic," said state Rep. Kyle Brown, a Democrat from Louisville. "And that strikes me as where we are at.
"I'm talking about an implosion of the safety net," he added.
The wind-down of the federal government's expansion of Medicaid during the public health emergency was always expected to pose a challenge for medical providers, some of whom staffed up when public money was flowing more freely.
But now there are signs that the transition from the federal health emergency may leave some medical providers worse off than they were in 2019.
During the pandemic, the uninsured rate fell to 4.6% in Colorado from the 6.5% who lacked health insurance before March 2020, according to the Colorado Health Access Survey.
State health officials don't know how many Coloradans are uninsured today. But HCPF Executive Director Kim Bimestefer told the JBC that her department believes the uninsured rate is higher than it was before the pandemic.
"We think that'll start to come down," she said. "But we are prepared for it (getting) worse before it gets better."
Lawmakers suspect that bureaucratic missteps at the state and local level are at least partly to blame for the drop in insured Coloradans. When the public health emergency ended in March 2023, a number of low-income families lost Medicaid coverage — and not all of those who still qualify for the program have successfully re-enrolled .
"In western Colorado, the No. 1 issue right now is the amount of uncompensated care that's coming through our clinics and hospitals," said Rep. Rick Taggart, a Grand Junction Republican who serves on the budget panel. "That would indicate that (Medicaid enrollment) went down way too far, and it's going to come back up fairly significantly."
Many who have applied are stuck in administrative limbo as counties work through long backlogs of applicants. Others may have been deterred by the bureaucracy itself; HCPF officials confirmed that applications can run as long as 40 pages for families with children.
One thing that would help: more automatic renewals of Medicaid recipients, whose eligibility can be verified electronically through other government systems, like state income tax data or whether they receive federal food stamp benefits.
Less than 60% of Colorado Medicaid renewals have been processed automatically in recent months, according to HCPF data. In 2023, 17 states processed 70% or more of their renewals this way, according to KFF , a health policy research firm.
Department officials told the JBC they're working on it — but it will take time and money to make the necessary technological improvements at the state and local level.
A rebound in Medicaid enrollment can't come soon enough for small rural health providers and places like Denver Health that provide extensive care to underserved populations, lawmakers say. But if it does occur, that means HCPF's budget overruns were just the tip of the iceberg.
Higher enrollment will demand that much more money out of a state budget that's already stretched beyond its capacity.
"This is a really hard time, and it's going to be hard for the next two years," Bimestefer said during the hearing. "We've just got to keep getting closer, understand what the dynamics are, and make impossible decisions without enough money."
END OF AN ERAThursday's Joint Budget Committee meeting was the last one for outgoing state Sen. Rachel Zenzinger, a term-limited Arvada Democrat who served on the JBC four of the last six years.
"This is a very, very privileged spot to be in the state legislature," said Zenzinger, who is now running for Jefferson County commissioner. "We are influencing big policies, and we have our fingerprints on every aspect of state government in these seats."
The Colorado GOP paid embattled Chairman Dave Williams' consulting firm $34,000 in August, the party's single biggest expense last month.
The party categorized $26,000 of that as "deferred payment of services." The remaining $8,000 was categorized as "chairman consulting."
The payments come as Williams is battling in court to keep his job as his opponents seek to replace him with Eli Bremer, who also claims to be the party's chairman after a vote in August organized by Williams' critics. The Colorado GOP also reported paying $25,000 into a trust account for legal expenses from the firm representing Williams in a lawsuit filed by Bremer seeking to dislodge him from the party's leadership position.
The Colorado GOP reported spending a total of $103,000 in August, none of which appears to have gone to help any Republican campaigns in the state. The party raised $26,500 last month and started September with $354,095.80 in cash on hand.
The $34,000 the party paid to Williams' consulting firm in August brings the total the Colorado GOP has paid to Fox Group Ltd. since Williams became chairman in March 2023 to $120,500. Williams' firm has been paid varying amounts by the party each month, but the sum averages out to $6,700 a month, or an annual salary of about $80,000.
Since Williams took over, the party has paid Treasurer Tom Bjorklund's consulting firm nearly $70,000, including $4,000 in August.
Bjorklund told The Sun that the party's executive board voted to set Williams' pay at $8,000 a month and his own pay at $4,000 a month.
The Colorado Democratic Party reported raising $536,693 in August and spending $276,446, including nearly $70,000 on mailers benefitting Democratic U.S. Rep. Yadira Caraveo's reelection campaign in the 8th Congressional District. The party had about $600,000 in cash on hand to begin September.
Former U.S. House Speaker Kevin McCarthy was in Colorado over the weekend where he visited with Republican congressional candidates Gabe EvansJeff Hurd. McCarthy posed for a photo with Bremer in the latest sign of which person national Republicans would like to see leading the Colorado GOP.
Meanwhile, attorneys for Williams and Bremer last week were duking it out in a series of fiery court filings. Williams' attorney, David Pigott, accused Bermer's lawyer, Chris Murray, of doing a bad and too-pricey job in his past representation of the party. Pigott is seeking to have Murray removed from the case.
Murray accused Pigott of "over-the-top rhetoric" and "little more than corrupt fictional confirmation bias."
The case, in which Bremer is suing Williams for control of the Colorado GOP, is set to go to trial in mid-October.
THE POLITICAL TICKERDemocratic U.S. Rep. Yadira Caraveo is running a new TV ad in the 8th Congressional District attacking her Republican opponent state Rep. Gabe Evans by calling him an "extreme MAGA Republican," comparing him to U.S. Rep. Lauren Boebert, and by claiming that he wants to ban abortion and invalidate gay marriages.
Evans has said that he wouldn't support a federal abortion ban, and a spokesperson told The Sun this week that he believes "the state should not be in the position of dictating who can and cannot get married." Evans plans to vote "yes" on a November ballot measure that would strip a prohibition on same-sex marriage from the Colorado constitution and supports the Respect for Marriage Act passed in 2022, which requires the federal government to recognize same-sex and interracial marriage.
The Caraveo campaign's claims about his stance on gay marriage stems in large part from a letter to the editor Evans wrote in 2004, when he was 17 years old, in which he called it a "bad idea" that will have a "terrible effect ... on our society." He wrote that allowing gay marriage would open the door to parents being able to marry their children and siblings, as well as incest, pederasty and bestiality.
The spokesperson pointed out how young Evans was when the letter was written and that "he shared the same position as Obama and many Democrats at the time."
PERA TRANSPARENCYStarting in November, the Colorado Public Employees' Retirement Association will begin posting recordings of its board meetings online like most other state committees do. Currently, the Board of Trustees livestreams its meetings on YouTube, but the recordings aren't available online after the meetings end. The change comes amid growing complaints from state officials about PERA's transparency.
PERA BOARDScott Smith, the chief financial officer of Cherry Creek Schools, resigned last week from PERA's Board of Trustees after being elected the president of the Colorado Association of School Executives. Smith frequently clashed with the board and its staff during his tenure. In his resignation letter, he complained to Executive Director Andrew Roth that "PERA appears to be one of the least transparent public organizations in the state." He also urged the pension system to improve its relationships with its member agencies, citing the substitute teacher lawsuit brought against PERA by a group of school districts.
ELECTION 2024Emily's List, the national group that supports women in politics, has endorsed Democrat Vivian Smotherman in her race to represent Senate District 6. Smotherman, a transgender woman, is running against Republican state Sen. Cleave Simpson of Alamosa. The endorsement comes with financial and technical support.
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YOU HEARD IT HEREThe debate was mostly substantive, focusing on water, fiscal and public lands policy, until the candidates were given the opportunity at the end to ask each other questions. Things devolved a bit at that point, with the candidates interrupting each other.
Hurd, when questioned by Frisch, wouldn't say how he will vote on Amendment 79 in November, the ballot measure that would amend the state constitution to further preserve unfettered abortion access, or whether he voted for Frisch or Republican U.S. Rep. Lauren Boebert in 2022.
Hurd painted Frisch as someone who couldn't be trusted. "Do you believe what Adam Frisch is saying?" Hurd said.
Another interesting moment during the debate was when Frisch tried to keep his Democratic affiliation at a distance.
"If there was a get-stuff-done party, I'd be in the get-stuff-done party," he said, highlighting how he was an unaffiliated voter for decades until his 2022 run for Congress in the district. "I was the first person in the entire country running for Congress as a Democrat to ask for President Biden to step down and pass the torch."
FOR THE RECORDThe Colorado Sun's reporting was the focus of part of the candidate question segment of the debate.
Hurd asked Frisch to explain how his campaign's decision to run ads in the Republican primary in the 3rd Congressional District lines up with his pledge to remove the drama from politics. Hurd pointed to The Sun's reporting on the ads and how they were aimed at persuading voters to back one of Hurd's five Republican primary candidates because the Frisch campaign saw them as easier to beat in November.
Frisch accused The Sun of editorializing and claimed that his campaign was just trying to get the ball rolling as the general election approached.
So you know: The Frisch campaign, which was contacted before the story ran, didn't complain about the content or the framing of the before or after it was published.
Frisch also suggested during the Club 20 debate that he spoke to The Sun about the ads. "When he asked me why, I gave him my answers," Frisch said of a Sun reporter.
Frisch never spoke to The Sun directly about the ads. The Frisch campaign sent a statement from Campaign Manager Camilo Vilaseca after initially offering an interview.
The Frisch campaign's primary ad attacking Hurd was shared by GOP supporters of Hurd's main primary opponent, former state Rep. Ron Hanks, including Colorado GOP Vice Chairwoman Hope Scheppelman
Frisch also ran an ad during the Republican primary boosting Hanks' profile, highlighting his anti-abortion and hard-line fiscal stances, as well as his similarities to the district's current representative, U.S. Rep. Lauren Boebert.
The Frisch campaign ads built off the $900,000 in spending during the Republican primary by Rocky Mountain Values PAC, a Democratic group that purchased TV and radio spots, as well as mailers and newspaper ads, elevating Hank's profile in the district and attacking Hurd .
Hurd went on to beat Hanks by a large margin.
Hurd, Frisch press each other on abortion, campaign tactics in first debate
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